OMB Control Num ber: 2060
- 0482 Expiration Date : 6/30/15

E PA Form # 5900
- 138 , Revised 7/14



### U.S. Environmental Protection Agency **STRA TOSPHERIC OZONE**  **PROTECTION PROGRA M**  

### CLASS I CONTROLLED SUBSTANCE METHYL BROMIDE **SA LES OF CRITICA**  **L US E METHYL BROMIDE**  **TO END USERS AN**  **NUA L**  **REPORT** 

### (40 **CFR 82.**  **13 )**  **NOTE** 

### : **FORM MUST BE COMPLET ED BY A**  **NY COMPA NY TH**  **AT PROVIDED METHYL BROM**  **IDE GA S OR FUMIGA** 

**TIO NS TO CRITICA**  **L USERS** 

### . **FORM MUST BE COMPLET ED BY A**  **CENTRA L OFFICE ON BE**  **HAL F OF THEIR DIVISI**  **ONS** 

### ; **ONE FORM PER COMPA NY**  

### . 

## SECTION 1 COMPANY IDENTIFICA **TION 1.1 Date of Submission**  **1.2 Year to Which This Report A pplies**  **1. 3**  **Original Submittal Re**  **- submittal**  **1. 4**  **Company Information**  Company Name Street Address City State Zip Code 

### 1. **5 Company Contact Identification**  Reporting Company Contact Person E
- mail Address Phone Number Fax Number 

### 1.6 Company Type **(check all that apply)** Distributor Third Party Applicator Producer Importer 

### 1.7 **Signature of Reporting Company Representative** I certify under penalty of law that I have personal ly examined and am familiar with the information submitted in this and all attached documents, and that based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the submitted information is true, accura te, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment. Name Title Signature Date 

## SEND COMPLETED FORMS TO: **For U.S. Postal Service:** U.S. EPA Stratospheric Protection Division Office of Atmos pheric Programs Mail Code: 6205T 1200 Pennsylvania Avenue, NW Wa shington, D.C. 20460 **For Private Courier:** U.S. EPA Stratospheric Protecti on Division Office of Atmospheric Programs Room 4355CC 1201 Constitution Avenue , NW Wa shington, D.C. 20004 A company may assert a claim of confidentiality for information submitted in this form by clearly marking that information as confidential. Such information shall be treated in accordance with EPA’s procedures for information claimed as confidential at 40 CFR Part 2, Subpart B, and will only be disclosed by the means set forth in the subpart. If no claim of confidentiality accompanies the report w hen it is received by EPA, it may be made public without further notice to the company (40 CFR 2.203). The public reporting and recordkeeping burden for this collection of inform ation is estimated to average 1.3 hours per response. Send comments on the A gency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing re spondent burden, including throu gh the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., N W, W ashington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the comple ted form to this address.OMB Control Num ber: 2060
- 0482 Expiration Date : 6/30/15

E PA Form # 5900
- 138 , Revised 7/14



### U.S. Environmental Protection Agency **STRA TOSPHERIC OZONE**  **PROTECTION PROGRA M**  

### CLASS I CONTROLLED SUBSTANCE METHYL BROMIDE **SA LES OF CRITICA**  **L US E METHYL BROMIDE**  **TO END USERS AN**  **NUA L**  **REPORT** 

### (40 CFR **82. 13**  **)** 

## SECTION **2 SA**  **LES DA**  **TA 2.**  **1 Company Name**  **2.2 Critical Use Methyl Bromide (newly produced or imported) sold (active ingredient only)**  ***** Pre
- Plant (kg) Post
- Harvest (kg) 

### Year **- End Inventory Calculation**  **2.3 .**  **A Beginning Inventory of Critical Use Methy**  **l Bromide from Prior Control Periods, if any (NOT pre**  **- phaseout stocks).**  **Note: This is the same amount as the previous control period’s ending inventory.**  ***** Pre
- Plant (kg) Post
- Harvest (kg)


### 2.3 **.B Critical Use Methyl Bromide Bought this Year (only new**  **production/import, NOT pre -**  **phaseout stocks)** ***** Pre
- Plant (kg) Post
- Harvest (kg)


### 2. **4 Critical Use Methyl Bromide Sold to an Entity Other than a**  **Critical User (e.g., Distributor, Thir d Party A**  **pplicator)** ***** Pre
- Plant (kg) Post
- Harvest (kg)


### 2. **5 Year**  **- End Inventory**  **– Critical Use Methyl Bromide**  **Not Sold In Reporting Year (2.3.A**  **+ 2.3 .B**  **– 2.2**  **– 2.**  **4 )**  ***** Pre
- Plant not sold by year end (kg) Post
- Harvest not sold by year end (kg) 

### 2. **6 Name(s) of Company(ies) for which Newly Produced Critical Use Methyl Bromide is Being Held and A**  **ssociated Am**  **ount (kg) Held for Each (excluding end -**  **users)** Company Name: Pre
- Plant (kg): Post
- Harvest (kg): 

### Company Name: Pre
- Plant (kg): Post
- Harvest (kg): 

### Company Name: Pre
- Plant (kg): Post
- Harvest (kg): **NOTE** 

### : **COMPLETE THE PRE** 

### - **2005 METHYL BROMIDE STOCK**  **S REPORT FOR QUA NTIT**  **IES OF METHYL BROMID E OWNED THA**  **T W AS**  **PRODUCED** 

### / **IMPORTED BEFORE JA NU**  **ARY** 

### 1, **2005.** *If none, enter 0. Do not leave blank.